NCCQ UK Theory Past Paper Practice
The requirement for national collection of the use of fifth characters appears in which four
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ICD-10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full
rr rr rr rr rr rr rr rr rr rr rr rr rr
titles are acceptable. [3 Marks] - ANS>>Chapter IX (9) Diseases of the circulatory
rr rr rr rr rr rr rr rr rr rr rr rr rr
system
rr rr
Chapter X (10) Diseases of the respiratory system
rr rr rr rr rr rr rr
Chapter XIII (13) Diseases of the musculoskeletal system and connective tissue
rr rr rr rr rr rr rr rr rr rr rr
Chapter XIX (19) Injury, poisoning and certain other consequences of external causes
rr rr rr rr rr rr rr rr rr rr rr
The circumstances surrounding reactions to drug/medication are classified in two ways
rr rr rr rr rr rr rr rr rr rr
within ICD-10 Tabular List, Volume 1. Name both ways. [2 Marks] - ANS>>Poisoning
rr rr rr rr rr rr rr rr rr rr rr rr rr
(improper use)
rr rr rr
Adverse effect (proper use) rr rr rr
What must a coder do if a surgical eponym is used in the medical record to describe a
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
procedure? [3 Marks] - ANS>>The coder must analyse the procedural information and
rr rr rr rr rr rr rr rr rr rr rr rr
ensure that code assignment fully reflects the procedure performed.
rr rr rr rr rr rr rr rr rr rr
Where the coder is unsure what procedure the eponym describes, they must seek advice
rr rr rr rr rr rr rr rr rr rr rr rr rr
from the responsible consultant to ensure that the correct codes are assigned.
rr rr rr rr rr rr rr rr rr rr rr rr
When should site codes from Chapter Z be assigned? [1 Mark] - ANS>>They must
rr rr rr rr rr rr rr rr rr rr rr rr rr
always be assigned when this adds further information about the site on which the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
procedure was performed
rr rr rr
What two conditions must be coded if a diagnosis of 'severe sepsis' alone is made by the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
clinician? No actual codes are required. [2 Marks] - ANS>>(A41.9) Sepsis (unspecified)
rr rr rr rr rr rr rr rr rr rr rr rr
(R65.1) Systemic Inflammatory Response Syndrome (SIRS) of infectious origin with
rr rr rr rr rr rr rr rr rr rr
organ failure
rr rr
What is the standard regarding the use of the OPCS-4.7 code X35.1 Intravenous
rr rr rr rr rr rr rr rr rr rr rr rr
induction of labour? [1 Mark] - ANS>>It must never be used.
rr rr rr rr rr rr rr rr rr rr rr
On what occasion is it a mandatory requirement to assign an OPCS-4.7 general
rr rr rr rr rr rr rr rr rr rr rr rr
anaesthetic code? [1 Mark] - ANS>>When radiotherapy is delivered under general
rr rr rr rr rr rr rr rr rr rr rr
anaesthetic, a code from category Y80 General anaesthetic must be assigned in addition
rr rr rr rr rr rr rr rr rr rr rr rr rr
to the radiotherapy delivery.
rr rr rr rr
When should codes from ICD-10 category Z54.- Convalescence be assigned and how
rr rr rr rr rr rr rr rr rr rr rr
should they be sequenced? No actual codes are required. [2 Marks] - ANS>>Never in
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
, primary. They must only be assigned in a secondary position when a patient has
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
received convalescence in a dedicated convalescent unit.
rr rr rr rr rr rr rr
How should an injury caused by a geriatric fall be coded? Describe the possible
rr rr rr rr rr rr rr rr rr rr rr rr rr
sequencing of these codes. No actual codes are required. [4 Marks] - ANS>>Code
rr rr rr rr rr rr rr rr rr rr rr rr rr
classifying the injury sustained (from Chapter XIX). External cause code to describe the
rr rr rr rr rr rr rr rr rr rr rr rr rr
fall (from categories W00-W19).
rr rr rr rr rr
(R29.6) Tendency to fall, (not elsewhere classified).
rr rr rr rr rr rr rr
In this sequence, unless the patient remains in hospital for investigation of the falls and
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
this becomes the primary focus of care, then this code (R29.6) must be sequenced
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
before the codes for the injury
rr rr rr rr rr rr
What must be coded when an excision and biopsy (excision biopsy) is performed on the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
same site during the same theatre visit, and why? No actual codes are required. [2
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Marks] - ANS>>Only assign a code(s) for the excision as a biopsy is an integral part of
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
an excision.
rr rr
When must codes from ICD-10 category Z38.- Liveborn infants according to place of birth
rr rr rr rr rr rr rr rr rr rr rr rr rr
be assigned in the primary coding field? [1 Mark] - ANS>>If the baby is a completely well
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
baby and has no morbid conditions that have been treated or investigated.
rr rr rr rr rr rr rr rr rr rr rr rr
During which procedure should OPCS-4.7 code X50.5 Evaluation of a cardiodefibrillator
rr rr rr rr rr rr rr rr rr rr
not be assigned when carried out? No actual codes are required. [1 Mark] - ANS>>When
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
testing is performed during the insertion of the cardioverter defibrillator (K59 Cardioverter
rr rr rr rr rr rr rr rr rr rr rr rr
defibrillator introduced through the vein or K72 Other cardioverter defibrillator).
rr rr rr rr rr rr rr rr rr rr
What precise wording, other than 'status asthmaticus', must be present in the medical
rr rr rr rr rr rr rr rr rr rr rr rr
records to be able to assign J46.X Status asthmaticus? [1 Mark] - ANS>>Acute severe
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
asthma
rr
How should a fracture fixation procedure be coded when the description names more
rr rr rr rr rr rr rr rr rr rr rr rr
than one type of fixation device, e.g. pin and plate? No actual codes are required. [2
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Marks] - ANS>>Only the main part of the device that is holding the fracture together must
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
be coded. When it is not clear which part of the fixation device is the main part holding
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the fracture together, advice must be sought from the responsible consultant.
rr rr rr rr rr rr rr rr rr rr rr
In accordance with national clinical coding standards, name the two specific forms of
rr rr rr rr rr rr rr rr rr rr rr rr
chest pain categorised to ICD-10 category R07 Pain in throat and chest. [2 Marks] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>Central chest pain
rr rr rr rr
Musculoskeletal chest pain rr rr
In ICD-10 coding terms, describe the difference between a 'rectal haemorrhage' and 'per
rr rr rr rr rr rr rr rr rr rr rr rr
rectal haemorrhage', and the coding standards related to these terms. No actual codes
rr rr rr rr rr rr rr rr rr rr rr rr rr
are required. [3 Marks] - ANS>>The code (K62.5) for 'haemorrhage of anus and rectum'
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
must only be assigned for an actual haemorrhage of the anus and/or rectum. It must not
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
, be assigned for haemorrhage that has occurred from elsewhere in the gastrointestinal
rr rr rr rr rr rr rr rr rr rr rr rr
tract that is merely exiting via the rectum, i.e. per rectal haemorrhage.
rr rr rr rr rr rr rr rr rr rr rr rr rr
The code (K92.2) for 'gastrointestinal haemorrhage, unspecified' must be assigned for a
rr rr rr rr rr rr rr rr rr rr rr
haemorrhage that occurred via the rectum (per rectal haemorrhage) but is not specified
rr rr rr rr rr rr rr rr rr rr rr rr rr
as being from the actual rectum or anus. This code must not be assigned when it is a
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
symptom of a specific disease which has been diagnosed.
rr rr rr rr rr rr rr rr rr
How must a colonoscopy with ileal intubation that includes a biopsy of the terminal ileum
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
be coded? No actual codes are required. [2 Marks] - ANS>>(H22.1) Diagnostic fibreoptic
rr rr rr rr rr rr rr rr rr rr rr rr rr
endoscopic examination of colon and biopsy of lesion of colon followed by the site code
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
(Z27.6) Ileum
rr rr
What clinical coding standards relating to the use of ICD-10 category O63 Long labour
rr rr rr rr rr rr rr rr rr rr rr rr rr
must the coder be aware of? [2 Marks] - ANS>>It must be documented in the medical
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
record that the labour or stage of labour is prolonged/long for this category to be used.
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
If the reason for the prolonged/long labour is stated, then this must be coded instead
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
When must the insertion of a nasogastric (NG) feeding tube be coded? [1 Mark] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>When a patient is admitted solely for the purpose of insertion.
rr rr rr rr rr rr rr rr rr rr rr
What is the OPCS-4 standard when a gastroscope is not able to be inserted further than
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the patient's mouth during an endoscopy? No actual codes are required. [1 Mark] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>The procedure must not be coded.
rr rr rr rr rr rr
The ICD-10 classification contains 22 chapters and is divided into three different chapter
rr rr rr rr rr rr rr rr rr rr rr rr
types. Name the three types of chapter. [3 Marks] - ANS>>Special group chapters
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Body system chapters rr rr rr
Other chapters rr
When there is doubt as to where a condition should be coded which of the three chapter
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
types found in the axis of the ICD-10 classification takes priority? [1 Mark] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>Where there is any doubt as to where a condition should be coded, the 'special
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
group' chapters must take priority.
rr rr rr rr rr
In order for an ICD-10 classification code to be valid what is the minimum character
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
length that it must be? Describe the structure of a code and how it must be extended as
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
documented in DRule.2: Category and code structure. [5 Marks] - ANS>>Four.
rr rr rr rr rr rr rr rr rr rr rr rr
Three character category codes must subdivided into four character subcategories.
rr
rr rr rr rr rr rr rr rr rr rr
Where a three character category code is not subdivided into four character subdivisions
rr rr rr rr rr rr rr rr rr rr rr rr
the 'X' filler must be assigned in the fourth character field so the codes are of a standard
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
length for data processing and validation.
rr
rr
rr rr rr rr rr rr
, Where a three character code requires assignment of both the 'X' filler and a fifth
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
character subdivision, the 'X' filler must continue to be recorded in the fourth field before
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the fifth character, for example M45.X3 Ankylosing spondylitis, cervicothoracic region.
rr rr rr rr rr rr rr rr rr rr
Where is the 'point dash (.-)' punctuation found in the ICD-10 classification and describe
rr rr rr rr rr rr rr rr rr rr rr rr rr
its purpose? [3 Marks] - ANS>>A point-dash is found in both the Tabular List and the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Alphabetical Index to indicate there are fourth character subdivisions.
rr rr rr rr rr rr rr rr rr
Unique identifiers (reference number) are applied to four areas of the National Clinical
rr rr rr rr rr rr rr rr rr rr rr rr
Coding Standards ICD-10 4th Edition (2015) reference book; flow charts are one of
rr rr rr rr rr rr rr rr rr rr rr rr rr
these, name the other three. [3 Marks] - ANS>>Rules
rr rr rr rr rr rr rr rr rr rr
Conventions rr
Standards
Name the three types of standard documented in the National Clinical Coding Standards
rr rr rr rr rr rr rr rr rr rr rr rr
ICD-10 4th Edition (2015) reference book. Briefly describe their locations within it and
rr rr rr rr rr rr rr rr rr rr rr rr rr
how they should be applied. [9 Marks] - ANS>>General coding standards are located at
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the beginning of the reference book and are applicable throughout the classification.
rr
rr
rr rr rr rr rr rr rr rr rr rr rr rr
Chapter standards are located at the beginning of an ICD-10 chapter of the reference
rr rr rr rr rr rr rr rr rr rr rr rr rr
book and are applicable throughout that chapter. Note that not all chapters will have
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
chapter standards.
rr
rr
rr rr
Coding standards are located throughout each ICD-10 chapter of the reference book and
rr rr rr rr rr rr rr rr rr rr rr rr
are applicable to a specific diagnosis, disorder, disease or condition, or describe the
rr rr rr rr rr rr rr rr rr rr rr rr rr
correct usage of a code, category or range of codes. Coding standards are, generally,
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
listed in code, category or range order.
rr rr rr rr rr rr rr
What must clinical coders take into account when coding a 'radical operation'? [3 Marks] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>When coding radical operations:
rr rr rr rr rr
Code assignment must fully reflect the procedure(s) performed during the radical
rr rr rr rr rr rr rr rr rr rr
operation.
rr rr
Instructional Notes must be applied in order to fully reflect all procedures performed. rr rr rr rr rr rr rr rr rr rr rr rr rr
Any uncertainty as to what procedures were performed during the radical operation must
rr rr rr rr rr rr rr rr rr rr rr rr
be clarified with the responsible consultant in order to ensure correct code assignment.
rr rr rr rr rr rr rr rr rr rr rr rr rr
What sequencing rules must be applied when a resection and reconstruction of an organ
rr rr rr rr rr rr rr rr rr rr rr rr rr
or site has been performed during the same theatre visit? [2 Marks] - ANS>>Where
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
resection and reconstruction have been performed the codes that classify the resection
rr rr rr rr rr rr rr rr rr rr rr rr
must be assigned before the codes that classify the reconstruction.
rr rr rr rr rr rr rr rr rr rr
What is being described when codes from OPCS-4.7 category V55 Levels of spine are
rr rr rr rr rr rr rr rr rr rr rr rr rr
assigned? [1 Mark] - ANS>>The number of levels being operated on.
rr rr rr rr rr rr rr rr rr rr rr
A level of spine can mean one of three things; what can they mean and give one example
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
of an operation specific to each meaning? [6 Marks] - ANS>>A 'level of spine' means
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
either a vertebra, a disc, or a motion segment.
rr
rr
rr rr rr rr rr rr rr rr
The requirement for national collection of the use of fifth characters appears in which four
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ICD-10 4th Edition chapters? Either chapter numbers (Arabic or Roman numeral) or full
rr rr rr rr rr rr rr rr rr rr rr rr rr
titles are acceptable. [3 Marks] - ANS>>Chapter IX (9) Diseases of the circulatory
rr rr rr rr rr rr rr rr rr rr rr rr rr
system
rr rr
Chapter X (10) Diseases of the respiratory system
rr rr rr rr rr rr rr
Chapter XIII (13) Diseases of the musculoskeletal system and connective tissue
rr rr rr rr rr rr rr rr rr rr rr
Chapter XIX (19) Injury, poisoning and certain other consequences of external causes
rr rr rr rr rr rr rr rr rr rr rr
The circumstances surrounding reactions to drug/medication are classified in two ways
rr rr rr rr rr rr rr rr rr rr
within ICD-10 Tabular List, Volume 1. Name both ways. [2 Marks] - ANS>>Poisoning
rr rr rr rr rr rr rr rr rr rr rr rr rr
(improper use)
rr rr rr
Adverse effect (proper use) rr rr rr
What must a coder do if a surgical eponym is used in the medical record to describe a
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
procedure? [3 Marks] - ANS>>The coder must analyse the procedural information and
rr rr rr rr rr rr rr rr rr rr rr rr
ensure that code assignment fully reflects the procedure performed.
rr rr rr rr rr rr rr rr rr rr
Where the coder is unsure what procedure the eponym describes, they must seek advice
rr rr rr rr rr rr rr rr rr rr rr rr rr
from the responsible consultant to ensure that the correct codes are assigned.
rr rr rr rr rr rr rr rr rr rr rr rr
When should site codes from Chapter Z be assigned? [1 Mark] - ANS>>They must
rr rr rr rr rr rr rr rr rr rr rr rr rr
always be assigned when this adds further information about the site on which the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
procedure was performed
rr rr rr
What two conditions must be coded if a diagnosis of 'severe sepsis' alone is made by the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
clinician? No actual codes are required. [2 Marks] - ANS>>(A41.9) Sepsis (unspecified)
rr rr rr rr rr rr rr rr rr rr rr rr
(R65.1) Systemic Inflammatory Response Syndrome (SIRS) of infectious origin with
rr rr rr rr rr rr rr rr rr rr
organ failure
rr rr
What is the standard regarding the use of the OPCS-4.7 code X35.1 Intravenous
rr rr rr rr rr rr rr rr rr rr rr rr
induction of labour? [1 Mark] - ANS>>It must never be used.
rr rr rr rr rr rr rr rr rr rr rr
On what occasion is it a mandatory requirement to assign an OPCS-4.7 general
rr rr rr rr rr rr rr rr rr rr rr rr
anaesthetic code? [1 Mark] - ANS>>When radiotherapy is delivered under general
rr rr rr rr rr rr rr rr rr rr rr
anaesthetic, a code from category Y80 General anaesthetic must be assigned in addition
rr rr rr rr rr rr rr rr rr rr rr rr rr
to the radiotherapy delivery.
rr rr rr rr
When should codes from ICD-10 category Z54.- Convalescence be assigned and how
rr rr rr rr rr rr rr rr rr rr rr
should they be sequenced? No actual codes are required. [2 Marks] - ANS>>Never in
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
, primary. They must only be assigned in a secondary position when a patient has
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
received convalescence in a dedicated convalescent unit.
rr rr rr rr rr rr rr
How should an injury caused by a geriatric fall be coded? Describe the possible
rr rr rr rr rr rr rr rr rr rr rr rr rr
sequencing of these codes. No actual codes are required. [4 Marks] - ANS>>Code
rr rr rr rr rr rr rr rr rr rr rr rr rr
classifying the injury sustained (from Chapter XIX). External cause code to describe the
rr rr rr rr rr rr rr rr rr rr rr rr rr
fall (from categories W00-W19).
rr rr rr rr rr
(R29.6) Tendency to fall, (not elsewhere classified).
rr rr rr rr rr rr rr
In this sequence, unless the patient remains in hospital for investigation of the falls and
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
this becomes the primary focus of care, then this code (R29.6) must be sequenced
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
before the codes for the injury
rr rr rr rr rr rr
What must be coded when an excision and biopsy (excision biopsy) is performed on the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
same site during the same theatre visit, and why? No actual codes are required. [2
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Marks] - ANS>>Only assign a code(s) for the excision as a biopsy is an integral part of
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
an excision.
rr rr
When must codes from ICD-10 category Z38.- Liveborn infants according to place of birth
rr rr rr rr rr rr rr rr rr rr rr rr rr
be assigned in the primary coding field? [1 Mark] - ANS>>If the baby is a completely well
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
baby and has no morbid conditions that have been treated or investigated.
rr rr rr rr rr rr rr rr rr rr rr rr
During which procedure should OPCS-4.7 code X50.5 Evaluation of a cardiodefibrillator
rr rr rr rr rr rr rr rr rr rr
not be assigned when carried out? No actual codes are required. [1 Mark] - ANS>>When
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
testing is performed during the insertion of the cardioverter defibrillator (K59 Cardioverter
rr rr rr rr rr rr rr rr rr rr rr rr
defibrillator introduced through the vein or K72 Other cardioverter defibrillator).
rr rr rr rr rr rr rr rr rr rr
What precise wording, other than 'status asthmaticus', must be present in the medical
rr rr rr rr rr rr rr rr rr rr rr rr
records to be able to assign J46.X Status asthmaticus? [1 Mark] - ANS>>Acute severe
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
asthma
rr
How should a fracture fixation procedure be coded when the description names more
rr rr rr rr rr rr rr rr rr rr rr rr
than one type of fixation device, e.g. pin and plate? No actual codes are required. [2
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Marks] - ANS>>Only the main part of the device that is holding the fracture together must
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
be coded. When it is not clear which part of the fixation device is the main part holding
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the fracture together, advice must be sought from the responsible consultant.
rr rr rr rr rr rr rr rr rr rr rr
In accordance with national clinical coding standards, name the two specific forms of
rr rr rr rr rr rr rr rr rr rr rr rr
chest pain categorised to ICD-10 category R07 Pain in throat and chest. [2 Marks] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>Central chest pain
rr rr rr rr
Musculoskeletal chest pain rr rr
In ICD-10 coding terms, describe the difference between a 'rectal haemorrhage' and 'per
rr rr rr rr rr rr rr rr rr rr rr rr
rectal haemorrhage', and the coding standards related to these terms. No actual codes
rr rr rr rr rr rr rr rr rr rr rr rr rr
are required. [3 Marks] - ANS>>The code (K62.5) for 'haemorrhage of anus and rectum'
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
must only be assigned for an actual haemorrhage of the anus and/or rectum. It must not
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
, be assigned for haemorrhage that has occurred from elsewhere in the gastrointestinal
rr rr rr rr rr rr rr rr rr rr rr rr
tract that is merely exiting via the rectum, i.e. per rectal haemorrhage.
rr rr rr rr rr rr rr rr rr rr rr rr rr
The code (K92.2) for 'gastrointestinal haemorrhage, unspecified' must be assigned for a
rr rr rr rr rr rr rr rr rr rr rr
haemorrhage that occurred via the rectum (per rectal haemorrhage) but is not specified
rr rr rr rr rr rr rr rr rr rr rr rr rr
as being from the actual rectum or anus. This code must not be assigned when it is a
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
symptom of a specific disease which has been diagnosed.
rr rr rr rr rr rr rr rr rr
How must a colonoscopy with ileal intubation that includes a biopsy of the terminal ileum
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
be coded? No actual codes are required. [2 Marks] - ANS>>(H22.1) Diagnostic fibreoptic
rr rr rr rr rr rr rr rr rr rr rr rr rr
endoscopic examination of colon and biopsy of lesion of colon followed by the site code
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
(Z27.6) Ileum
rr rr
What clinical coding standards relating to the use of ICD-10 category O63 Long labour
rr rr rr rr rr rr rr rr rr rr rr rr rr
must the coder be aware of? [2 Marks] - ANS>>It must be documented in the medical
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
record that the labour or stage of labour is prolonged/long for this category to be used.
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
If the reason for the prolonged/long labour is stated, then this must be coded instead
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
When must the insertion of a nasogastric (NG) feeding tube be coded? [1 Mark] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>When a patient is admitted solely for the purpose of insertion.
rr rr rr rr rr rr rr rr rr rr rr
What is the OPCS-4 standard when a gastroscope is not able to be inserted further than
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the patient's mouth during an endoscopy? No actual codes are required. [1 Mark] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>The procedure must not be coded.
rr rr rr rr rr rr
The ICD-10 classification contains 22 chapters and is divided into three different chapter
rr rr rr rr rr rr rr rr rr rr rr rr
types. Name the three types of chapter. [3 Marks] - ANS>>Special group chapters
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Body system chapters rr rr rr
Other chapters rr
When there is doubt as to where a condition should be coded which of the three chapter
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
types found in the axis of the ICD-10 classification takes priority? [1 Mark] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>Where there is any doubt as to where a condition should be coded, the 'special
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
group' chapters must take priority.
rr rr rr rr rr
In order for an ICD-10 classification code to be valid what is the minimum character
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
length that it must be? Describe the structure of a code and how it must be extended as
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
documented in DRule.2: Category and code structure. [5 Marks] - ANS>>Four.
rr rr rr rr rr rr rr rr rr rr rr rr
Three character category codes must subdivided into four character subcategories.
rr
rr rr rr rr rr rr rr rr rr rr
Where a three character category code is not subdivided into four character subdivisions
rr rr rr rr rr rr rr rr rr rr rr rr
the 'X' filler must be assigned in the fourth character field so the codes are of a standard
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
length for data processing and validation.
rr
rr
rr rr rr rr rr rr
, Where a three character code requires assignment of both the 'X' filler and a fifth
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
character subdivision, the 'X' filler must continue to be recorded in the fourth field before
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the fifth character, for example M45.X3 Ankylosing spondylitis, cervicothoracic region.
rr rr rr rr rr rr rr rr rr rr
Where is the 'point dash (.-)' punctuation found in the ICD-10 classification and describe
rr rr rr rr rr rr rr rr rr rr rr rr rr
its purpose? [3 Marks] - ANS>>A point-dash is found in both the Tabular List and the
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
Alphabetical Index to indicate there are fourth character subdivisions.
rr rr rr rr rr rr rr rr rr
Unique identifiers (reference number) are applied to four areas of the National Clinical
rr rr rr rr rr rr rr rr rr rr rr rr
Coding Standards ICD-10 4th Edition (2015) reference book; flow charts are one of
rr rr rr rr rr rr rr rr rr rr rr rr rr
these, name the other three. [3 Marks] - ANS>>Rules
rr rr rr rr rr rr rr rr rr rr
Conventions rr
Standards
Name the three types of standard documented in the National Clinical Coding Standards
rr rr rr rr rr rr rr rr rr rr rr rr
ICD-10 4th Edition (2015) reference book. Briefly describe their locations within it and
rr rr rr rr rr rr rr rr rr rr rr rr rr
how they should be applied. [9 Marks] - ANS>>General coding standards are located at
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
the beginning of the reference book and are applicable throughout the classification.
rr
rr
rr rr rr rr rr rr rr rr rr rr rr rr
Chapter standards are located at the beginning of an ICD-10 chapter of the reference
rr rr rr rr rr rr rr rr rr rr rr rr rr
book and are applicable throughout that chapter. Note that not all chapters will have
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
chapter standards.
rr
rr
rr rr
Coding standards are located throughout each ICD-10 chapter of the reference book and
rr rr rr rr rr rr rr rr rr rr rr rr
are applicable to a specific diagnosis, disorder, disease or condition, or describe the
rr rr rr rr rr rr rr rr rr rr rr rr rr
correct usage of a code, category or range of codes. Coding standards are, generally,
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
listed in code, category or range order.
rr rr rr rr rr rr rr
What must clinical coders take into account when coding a 'radical operation'? [3 Marks] -
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
ANS>>When coding radical operations:
rr rr rr rr rr
Code assignment must fully reflect the procedure(s) performed during the radical
rr rr rr rr rr rr rr rr rr rr
operation.
rr rr
Instructional Notes must be applied in order to fully reflect all procedures performed. rr rr rr rr rr rr rr rr rr rr rr rr rr
Any uncertainty as to what procedures were performed during the radical operation must
rr rr rr rr rr rr rr rr rr rr rr rr
be clarified with the responsible consultant in order to ensure correct code assignment.
rr rr rr rr rr rr rr rr rr rr rr rr rr
What sequencing rules must be applied when a resection and reconstruction of an organ
rr rr rr rr rr rr rr rr rr rr rr rr rr
or site has been performed during the same theatre visit? [2 Marks] - ANS>>Where
rr rr rr rr rr rr rr rr rr rr rr rr rr rr
resection and reconstruction have been performed the codes that classify the resection
rr rr rr rr rr rr rr rr rr rr rr rr
must be assigned before the codes that classify the reconstruction.
rr rr rr rr rr rr rr rr rr rr
What is being described when codes from OPCS-4.7 category V55 Levels of spine are
rr rr rr rr rr rr rr rr rr rr rr rr rr
assigned? [1 Mark] - ANS>>The number of levels being operated on.
rr rr rr rr rr rr rr rr rr rr rr
A level of spine can mean one of three things; what can they mean and give one example
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
of an operation specific to each meaning? [6 Marks] - ANS>>A 'level of spine' means
rr rr rr rr rr rr rr rr rr rr rr rr rr rr rr
either a vertebra, a disc, or a motion segment.
rr
rr
rr rr rr rr rr rr rr rr
